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What is the importance of treating pressure ulcers immediately, especially in elderly patients?

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Figure A

Pressure ulcers present with many etiologies. In the protocol outlined, the treatment is almost always the same regardless of etiology. Specifically, it is the basis of this protocol that all new pressure ulcers be treated immediately upon recognition.

Figure A: A 91-year-old woman with sacral ulcer. This patient was treated immediately, and subsequently her venous stasis ulcer healed rapidly (Figure B) under the protocol. No debridement or culture was needed. This is a typical example of how early treatment halts ulcer progression. This patient became progressively wheelchair-bound and was instructed to report any new break in the skin. Almost all pressure ulcers present in a similar fashion, i.e., as a break in the skin.

 

What should the protocol be for bed-bound or wheelchair-bound patients to prevent any type of wound?

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Figure C

 

FIgure C: In contrast to the case depicted above in Figures A and B, this previously healthy 96-year-old man had also become progressively wheelchair-bound but presented with an infected stage IV pressure ulcer requiring operative debridement. He healed on the protocol (Figure D) but would have avoided the morbidity and expense of a stage IV ulcer if he had presented upon first recognition. This case also emphasizes that every wheelchair- or bed-bound patient must be examined daily and the protocol initiated immediately upon recognition of a break in the skin.

 

The American Journal of Surgery 188 (Suppl to July 2004) 9S–17S
Protocol for the successful treatment of pressure ulcers
Harold Brem, M.D., Jan Young, Ph.D., Cary Isaacs, M.S.,Marjana Tomic-Canic, Ph.D.
H. Paul Ehrlich, Ph.D.